Closing the knowledge gap is an essential skill for the DNP practice scholar. Reflect upon your application of evidence-based practice and professional formation to consider the following.

• What process do you employ to identify knowledge gaps in your nursing practice?
• What strategies will you use to overcome these knowledge gaps?
• As a leader in healthcare, how will you maximize others’ potential as they overcome knowledge gaps?
• How will you lead evidence-based practice at your workplace?

Please answer these questions separated and use at least 3 sources no later than 5 years.

Begin reviewing and replying to peer postings/responses early in the week to enhance peer discussion. See the rubric for participation points. Participate in the discussion by asking a question, providing a statement of clarification, providing viewpoints with a rationale, challenging aspects of the discussion, or indicating relationships between two or more lines of reasoning in the discussion. Always use constructive language, even in criticism, to work toward the goal of positive progress.

Peer 1

Topic 1:  Causes of Death

The CDC’s website makes data available for different causes of death, and some studies break it down by ethnicities.   According to to data from the National Vital Statistics System, in 1999 there was a gap in life expectancy between white and black ethnicities, with white people living an average of 5.9 years longer than their African-american counterparts (cdc.gov, 2020).  

It appears that the last time data was published for this statistic was in 2013, and at tht time, the gap had decreased to 3.6 years between the two groups.  

            The decrease is attributed to a decrease in death rates in the black population from “heart disease, cancer and HIV disease (cdc.gov, 2020).”  This tells me that there is hope, but still a lot of work needs to be done.  Putting this in years, the average white person can expect to live 79.1 years, and the average black person may expect to live 75.5 years (cdc.gov, 2020).  Those years in the gap are probably important to most actual people.  Many of the issues explored by the Healthy People 2030 Project regarding Social Determinants of Health have some influence on life expectancy.  For example, for my aggregate in this class project, 2/3 are African American. (I am referring to the 3 people we may use to gather data.)  Proportionately, I have not done a database search by ethnicity on the free clinic’s patients, because the software is cheap and does not allow this, but I suspect that one ethnicity is represented more than another, based on the day to day patient loads I’ve seen.  

            The nursing workforce may have some impact on these trends in many ways.  Political activism and providing volunteer services to the community within one’s scope of practice are two ways, off the top of my head, that we may help to change this discrepancy.

References

Centers for Disease Control and Prevention, (2020).  Leading Causes of Death Contributing to Decrease in Life Expectancy Gap Between Black and White Populations: United States, 1999-2013.  Retrieved from https://www.cdc.gov/nchs/products/databriefs/db218.htm

U. S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, (2020).  Healthy People 2030:  Social Determinants of Health.  Retrieved from https://health.gov/healthypeople/objectives-and-data/social-determinants-health

Peer 2

Topic 2: Responsibilities of a Nurse

Bachelor prepared nurses are important to the delivery of care and the coordination of care. They possess a broad knowledge base for healthcare delivery. In contrast, the Master of Science in Nursing (MSN) degree prepares at the specialty level. The MSN prepared nurse has education in a specialty field. A Nurse Practitioner (NP) is prepared at this level. The advanced practice nurse or NP is a licensed professional that is prepared at the master’s or doctorial level for advanced nursing practice and leadership roles in a community (Stanhope & Lancaster, 2020). These nurses use their critical thinking skills along with the nursing process to achieved specific health outcomes. They are autonomous and frequently work independently in clinics. There are many NPs in my community. They work in primary care clinics with patients of all ages. They are utilized as physician extenders at the local community hospital. Along with the strategic location of community health care clinics in my community, the NPs provide increased access to healthcare. In the state of Georgia, an NP can work independently, diagnose and write prescriptions. They can also order labs and diagnostic studies. To becomes an NP in the state of Georgia, one must hold an unrestricted Registered Nurse license, be a graduate of an accredited MSN program, and pass the National NP Certification exam (American Association of Nurse Practitioners [AANP], 2020). NPs are valuable to healthcare delivery because they treat the sick and they work to promote wellness. In my experience, nurses are prepared to be excellent educators. When I have had to visit an NP, I generally receive very in-depth teaching unlike when I see a physician.  

References: 

American Association of Nurse Practitioners. (2020). The path to becoming a Nurse Practitioner (NP). Retrieved November 16, 2020, from https://www.aanp.org/news-feed/explore-the-variety-of-career-paths-for-nurse-practitioners 

Stanhope, M., & Lancaster, J. (2020). Public health nursing: Population-centered health care in the community (10 th ed.). Elsevier. https://doi.org/https://digitalbookshelf.southuniversity.edu/#/books/9

PLEASE ANSWER ALL QUESTIONS AND PROVIDE REFERENCES. LATE ASSIGNMENTS WILL NOT BE ACEPTED. UPLOAD  ASSIGNMENT TO CANVAS. 

1.The nurse working in the cardiac procedures area receives a patient who has undergone a cardiac catheterization via the right femoral artery for evaluation of unstable angina. Prior to the procedure, the patient was NPO for 12 hours, and received a sedative. An IV catheter was placed for administration of the contrast agents and for access in case of an emergency situation. (Learning Objective 6)

1. What is the rationale for assessing distal pulses immediately after the catheterization?

2.What other assessments should the nurse perform to check for arterial insufficiency?

3.The patient asks why he needs to stay in bed with the leg extended for 2 to 6 hours. How should the nurse respond?

4 After the procedure, why is it important to assess the patient’s BUN, creatinine, and fluid volume status?

 Workplace Environment Assessment 

 After completing, write a one page paper (typed, single spaced, 12 font, and 1 inch margin) on who, where, when, and how this made you feel. Minimum of 500 words . 

grocery shopping for elderly (DOING FOR MY HOUSE OWNER SHE IS 69 YEARS)

see attached

Case Discussion Pulmonary – Part 2 Follow up Visit

Purpose

The purpose of this assignment is for students to:

1. Improve their ability to formulate diagnoses based on the clinical presentation of patients
2. Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders
3. Design a relevant treatment plan

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1. Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
2. Develop management plans based on current scientific evidence and national guidelines. (PO 5)
3. Educate patients on treatment decisions (WO1)
4. Select an evidence-based article to support the plan of care for the case study patient. (WO2)
5. Analyze national guidelines and apply them to specific case study situations. (WO3)
6. Review appropriate antibiotic prescribing guidelines. (WO4)

Requirements: (IMPORTANT INFORMATION HERE)

Michelle continues to work in the bakery and her asthma has been well controlled on a low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol prn which she uses 1-2 times per week. Michelle presents to the clinic with an acute illness that developed 2 days ago and has a respiratory rate of 24, mild SOB with exertion, O2 saturation of 94%, and complaint of inspiratory and expiratory wheezing. She is able to speak and states her temperature over the last 2 days has been 101 to 102 F. Cough is productive of white sputum. Influenza A is going around the bakery. Exam findings show a woman who appears her stated age and is alert and oriented and though calm, is having mild work of breathing. AR 110 BPM, BP is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough, is mildly short of breath, fair chest expansion, + inspiratory/expiratory wheezes, no rales, no rhonchi. Auscultation reveals no thrills, gallops or extra heart sounds. Apical rate is elevated at 110. Physical exam is otherwise unremarkable. The MA has swabbed her for Influenza A- test is positive.

Discussion Questions Part Two:

1. Determine an appropriate treatment plan for Michelle. Discuss medications, doses, Durable Medical Equipment, and any testing, and apply these directly to her case. Provide your rationale with evidence.
2. Decide whether she is safe to return home, include any prescriptions, or if a referral to a higher level of care is required. Discuss the criteria used to make your decision, how a referral is made, and defend your position.
3. Discuss relevant education and follow up plan.

DISCUSSION CONTENT 

Application of Course Knowledge  

Post contributes clinically accurate perspectives/insights applicable to the results from the physical exam and new diagnoses. Initial post includes the most likely diagnosis/specific treatment plan given case study information supported by rationale and answers all questions presented in the case. Demonstrates course knowledge/assigned readings by: linking tests/interventions accurately to diagnoses, applies learned knowledge specifically to the symptoms and patient information using original dialogue i.e., little to no direct quotes.  

Evidence Based resources  

Discussion post supported by evidence from appropriate sources published within the last five years. The focus of journal articles represents a logical link between the article content and the case study information.  In-text citations and full references are provided. 

DISCUSSION FORMAT 

Category 

Organization  

Discussion post presented in a logical, meaningful, and understandable sequence. Headings reflect the separation of criterion outlined in assignment guidelines.  

**Direct quote should not exceed 15 words & must add substantively to the discussion 

APA/Grammar/Spelling 

Discussion post has minimal grammar, spelling, syntax, punctuation and APA* errors. Direct quotes (if used) is limited to 1 short statement** which adds substantively to the post.  

* APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included. 

On one page, describe your philosophy of nursing.

The definition of philosophy is having a personal and specific outlook and approach you can use to make decisions and take action. Your philosophy of nursing should include your beliefs and attitudes about nursing, being a nurse, your approach to caring for others. It can also include your attitudes about working in healthcare facilities, working as part of a team, or even how you feel about people in general.

Save a copy of your philosophy as you will want to refer to it during your Program.

Assignment as been attached.

1. Prepare examples of various coding and billing issues that you have experienced in the clinical setting (Peds and women’s health).

2. Provide a brief description about the NPI numbers for nurse practitioners.

Answer: 

According to the American Academy of Pediatricians. (2020), current Procedural Terminology (CPT) has specific guidelines for using time as a key factor in determining the level of evaluation and management (E/M) service. First, it is paramount to remember the key factors in determining the level of CPT code which include history, physical examination, and medical decision making for the service. The level of selecting most E/M codes would be determined by these three key factors. In the pediatric practice, pediatricians’ needs to take into consideration the additional time they spent with patients, because it might change the level of coding that is used. On the other hand, time is the key factor when the counseling, coordination of care, or both account for more than fifty percent of the face-to-face time with the patient and/or family. When this situation occurs, it is necessary to enter the total duration of counseling and/or coordination of care into the clinical notes, as well as a description of the counseling and/or coordination of care that took place.

 For example, this future practitioner has performed a detailed history and examination, with the decision making as low complexity, and sixty minutes are spent with the patient; forty minutes of which are spent counseling the patient, the visit is coded 99205 which CPT guidelines indicate has a typical time of 60 minutes rather than 99203, which CPT guidelines indicate has a typical time of 30 minutes, for a new patient. (AAP, 2020). Besides, other issue in the office and other outpatient visits is that face-to-face time is defined as the amount of time the practitioner spends in the room with the patient. It does not include any other nurse time preparing the patient or giving injections. Coding to a general level or under coding could lead to a rejected or denied claim.

The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). The numbers do not carry other information about healthcare providers. As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that might need it for billing purposes

References

American Academy of Pediatricians. (2020). Coding Tips for Pediatricians: Evaluation and

Management Coding Strategies. Retrieved from https://www.aap.org/en-us/professional-resources/practice-transformation/getting-paid/Coding-at-the-AAP/Pages/Coding-Tips-for-Pediatricians-Evaluation-and-Management-Coding-Strategies.aspx

American Academy of Pediatricians. (2020). 2020 Coding and Reimbursement Tip Sheet for

Transition from Pediatric to Adult Health Care. Retrieved from https://www.gottransition.org/resource/? 2020-coding-tip-sheet

CMS. 2019. National Provider Identifier Standard (NPI). Retrieved from

https://www.cms.gov/Regulations-and-Guidance/Administrative-  Simplification/NationalProvIdentStand